Isolated metastatic melanoma to the gallbladder: is laparoscopic cholecystectomy indicated?: a case report and review of the literature

Metastatic involvement of the gallbladder in melanoma is rare, but constitutes the most common metastatic lesion involving this organ. The surgical management seems to be indicated for patients with isolated and resectable gallbladder metastases to avoid symptoms or tumor complications. We report on a case of a young woman with an isolated metastatic gallbladder melanoma who presented with symptoms of acute cholecystitis. The patient underwent laparoscopic cholecystectomy (LC) and lymphadenectomy of the hepatoduodenal ligament. Histology was characteristic for metastatic malignant melanoma. Nodes were negative for metastases. We emphasize the appropriateness of a laparoscopic approach, once ruled out a widespread metastatic disease. It can be done with a remarkably low rate of complications. Gentle manipulation, avoidance of perforation, and use of a retrieval bag for the removal of the gallbladder should be practiced to help minimize the chance of mechanical exfoliation or implantation of malignant cells during LC. In isolated metastatic localization, LC may be curative and provide adequate palliation of symptoms with a short convalescence and a fast recovery.     

Acute severe cholecystitis with empyema presenting as a gallbladder mass,jaundice and Mirizzi Syndrome: A case report

IntroductionAcute severe cholecystitis with empyema presenting as a gallbladder mass, jaundice and Mirizzi Syndrome (MS) is a complex surgical problem both diagnostically and in terms of management as it mimics both xanthogranulomatous cholecystitis (XGC) and gallbladder carcinoma.Presentation of caseA 48-year-old gentleman was referred to us with biliary colic and weight loss with ultrasound findings of gallstones. At subsequent follow-up he became deeply jaundiced with deranged liver function and a CT showing a gallbladder mass and dilated biliary tree. Follow-up MRCP suggested XGC and concomitant MS, but a malignant process could not be excluded. Pre-operative fine needle aspiration cytology (FNAC) at the time of percutaneous biliary drainage for his jaundice demonstrated XGC with no evidence of malignancy. Given the dense inflammation and a tense empyema at laparoscopy, he underwent a subtotal fenestrating cholecystectomy. The final histopathological diagnosis was acute cholecystitis.DiscussionOur patient likely had unrecognised acute cholecystitis which progressed to a complex mass with empyema and type I Mirizzi Syndrome, ultimately resulting in severe obstructive jaundice mimicking gallbladder carcinoma. Given that a laparoscopic total cholecystectomy is dangerous in these cases of severe inflammation, a laparoscopic subtotal cholecystectomy has been shown to be a safe alternative to more invasive strategies and was successfully utilised in our patient.ConclusionAcute severe cholecystitis with empyema presenting as a gallbladder mass, jaundice and Mirizzi Syndrome is a rare manifestation that requires adequate pre-operative work-up to exclude malignancy. Subtotal fenestrating cholecystectomy is a safe and effective alternative to open surgery in these cases of complex inflammation.     

Polypoid Lesions of the Gallbladder in Children

Polypoid lesions of the gallbladder in children are rare. We report a case of a gallbladder polyp in a 14-year-old boy who presented with recurrent right upper quadrant abdominal pain. Ultrasound examination of the abdomen revealed a polypoid lesion of the gallbladder. His symptoms resolved after laparoscopic cholecystectomy. Histological examination of the gallbladder demonstrated a benign adenomatous polyp. Although the experience with polypoid lesions of the gallbladder in children is limited, we currently recommend cholecystectomy because these lesions are associated with acalculous cholecystitis, and because their long-term effects are unknown.     

Malignant Melanoma of the Gallbladder: A Report of Two Cases and Review of the Literature

Melanoma metastatic to the gallbladder is rare. When present, it is often part of a widespread complex of metastases. Primary gallbladder melanomas are also extremely rare and can sometimes be difficult to distinguish from metastatic lesions. The optimal treatment for malignant melanoma of the gallbladder remains unclear, and prognosis is generally poor. We present here two cases of patients with metastatic lesions to the gallbladder. One patient presented with symptomatic cholelithiasis and was found incidentally to have a metastasis. Another patient had known a metastasis, but underwent curative resection of the only site of disease. We review the published literature for gallbladder melanoma, both primary and metastatic to determine the role of surgery in this disease.     

Laparoscopic cholecystectomy--results of the first 100 cases]

100 patients underwent laparoscopic cholecystectomy for symptomatic gallbladder stones. In seven cases the laparoscopic procedure had to be converted into an open cholecystectomy due to bleeding, choledochus injury and acute cholecystitis. There were no complications postoperatively. We feel that the indication of this method is advantageous. Independent of the size, the number and the chemical composition, this method is used for symptomatic gallbladder stones. All together the main advantages are higher comfort for the patient, better cosmetic results, shortening of hospital stay and sooner return to full activity.     

经皮肝胆囊穿刺引流联合腹腔镜胆囊切除治疗急性化脓性胆囊炎

【摘要】 目的 探讨经皮肝胆囊穿刺引流联合腹腔镜胆囊切除治疗急性化脓性胆囊炎的疗效。方法 回顾性分析我院及佛山市第一人民医院2009年1月至2012年12月82例急性化脓性胆囊炎先行经皮肝胆囊穿刺引流,1个月后再行腹腔镜胆囊切除术的临床资料。结果 82例患者均成功接受经皮肝胆囊穿刺引流,患者穿刺术后2~4 h腹痛明显缓解,术后2至3天体温降至正常。1例术后出现胆道大出血,经急诊肝动脉栓塞止血。全部患者于术后一个月行二期腹腔镜胆囊切除术,其中2例中转开腹(2.4%),术后无胆汁漏及胆管损伤等严重并发症发生。 结论 急性化脓性胆囊炎经皮肝胆囊穿刺引流可迅速缓解症状,术后1个月再实施腹腔镜胆囊切除术是安全、可行的,中转开腹率低,手术并发症少。     

Gallstone in a hernia sac

Perforation of the gallbladder with spillage of stones into the abdominal cavity is relatively common during laparoscopic cholecystectomy. We report a patient presenting with a symptomatic groin hernia 10 days after laparoscopic cholecystectomy for acute cholecystitis. The hernia sac was found to contain a gallstone. The patient underwent an uneventful hernia repair. Various complications due to retained gallstones have been described as case reports emphasizing how important it is to prevent perforation of the gallbladder or else make an effort to retrieve spilled stones from the abdomen.     

Hemorrhagic cholecystitis as a likely cause of nontraumatic hemobilia in metachromatic leukodystrophy: report of a case

A 17-years-old man with the juvenile form of MLD developed massive hemobilia. CT and US scans showed blood and clots filling the gallbladder and the biliary ways, with no bleeding source seen at selective angiography. Explorative laparotomy evidenced bleeding from a papillomatous gallbladder mucosa, resolved with cholecystectomy. Histologic examination with specific colorations diagnosed hemorrhagic cholecystitis from metachromatic leukodystrophy of the gallbladder. This is, to our knowing, the third case reported in Literature, and thus hemorrhagic cholecystitis may be considered a life-threatening complication of MLD to be prevented with cholecystectomy as soon as signs of gallbladder pathology (papillomatosis/polyposis, jaundice, abdominal pain) are suspected.     

Significance of preoperative ultrasound measurement of gallbladder wall thickness

Evaluation of patients with signs and symptoms of biliary tract disease usually includes ultrasound assessment of the gallbladder. Does measurement of the thickness of the gallbladder wall yield any significant information to the clinical surgeon? The records of all my patients undergoing cholecystectomy since 1990 were reviewed. The entire series consists of 401 consecutive patients, in whom 388 procedures were completed laparoscopically, with 14 patients requiring conversion to an open cholecystectomy. Each patient's preoperative evaluation included a gallbladder ultrasound, which included measurement of the diameter of the gallbladder wall. The entire series of cholecystectomies was evaluated according to the ultrasound measured diameter of the gallbladder wall. A thin gallbladder wall was less than 3 mm in diameter. A thick gallbladder wall was 3 mm or greater in diameter. Of the 401 consecutive patients who underwent cholecystectomy for symptomatic gallbladder disease, 86 (21.5%) were removed laparoscopically for acalculous disease. Eleven per cent of patients with acalculous cholecystitis had acute cholecystitis and 89 per cent had chronic cholecystitis. Every patient with either a thin or thick gallbladder wall with acalculous cholecystitis had a successful laparoscopic cholecystectomy. Three-hundred fifteen patients had a laparoscopic cholecystectomy for calculous cholecystitis. In patients with calculous cholecystitis, 28.3 per cent had acute cholecystitis and 71.7 per cent had chronic cholecystitis. The gallbladder wall was found to be greater than 3 mm in 38 per cent of patients with acute calculous cholecystitis and greater than 3 mm in 41 per cent of patients with chronic calculous cholecystitis. One-hundred, forty-two patients, out of a series total of 401, had a gallbladder wall thickness greater than 3 mm by preoperative sonography and 14 of these patients (10%) required conversion to an open cholecystectomy. A preoperative gallbladder ultrasound evaluation for symptomatic cholecystitis, which documents a thick gallbladder wall (> or =3 mm) with calculi, is a clinical warning for the laparoscopic surgeon of the potential for a difficult laparoscopic cholecystectomy procedure which may require conversion to an open cholecystectomy procedure.     

腹腔镜胆囊切除术适应证的探讨

目的　探讨不加选择的情况下腹腔镜胆囊切除术的适应证及临床疗效。　方法　总结 1998年～ 2 0 0 1年 8月未加选择连续实施的 2 4 3例腹腔镜胆囊切除术 ,分析其中转开腹率和手术疗效。　结果　全组 2 4 3例LC病人中共有 3例分别因胆囊床出血、胆管损伤、十二指肠与胆囊致密粘连胆囊三角解剖不清而中转开腹手术 ,中转开腹率为 1.2 %。术中并发症发生率为 1.2 % (3 2 4 3) ,术后并发症发生率为 0 .8% (2 2 4 3) ,总的手术并发症发生率为 2 .1% (5 2 4 3)。　结论　腹腔镜胆囊切除术对于规范化培训过的腹腔镜医师而言即使是急性期和萎缩性胆囊炎病人 ,也可在不明显增加手术并发症和中转开腹率的情况下安全地实施 ,所以LC适应证可以拓宽至 98%以上的有症状胆囊疾病患者。     

黄色肉芽肿性胆囊炎与胆囊癌的鉴别诊断及术中决策

黄色肉芽肿性胆囊炎是一种少见类型的胆囊炎,发病机制尚未完全清楚。因其胆囊壁弥漫性不均匀增厚及向周围器官浸润等特点而与胆囊癌难以鉴别,其病史体征、肿瘤标记物及影像学特点均不典型,加之部分病例合并有胆囊癌,术前难以做出确定性诊断。术前和术中细针穿刺冰冻病理学检查的诊断率相对较高,对手术方式选择有重要参考意义。因腹腔镜胆囊切除术的术中中转开腹率及并发症发生率很高,故临床多选择开腹胆囊切除术,依术中所见及冰冻病理学检查结果选择恰当的术式。     

腹腔镜下顺逆结合切除胆囊预防胆管损伤并发症的价值

目的 :探讨腹腔镜下顺逆结合切除胆囊预防胆管损伤并发症的临床价值。方法 :回顾分析腹腔镜下顺逆结合切除胆囊 1 2 6例的临床资料。 1 2 6例中胆囊结石伴胆囊萎缩 2 9例 ,急性、亚急性胆囊炎 86例 ,胆囊结石伴慢性胆囊炎 8例 ,胆囊息肉 3例。结果 :1例患者并发毛细胆管漏 ,经引流 3d痊愈 ,余患者均顺利恢复 ,无胆管损伤病例 ,无出血、感染及死亡等严重并发症发生。中转开腹 2例 ,1例胆囊结石伴胆囊萎缩 ,1例亚急性胆囊炎。平均手术时间 4 6min ,平均术后住院 4d。结论 :腹腔镜下顺逆结合切除胆囊能提高腹腔镜胆囊切除术的成功率 ,减少了腹腔镜下胆囊切除术胆管损伤并发症的发生 ,特别是在Calot三角解剖不清及变异时。     

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??Differential diagnosis and management strategies of xanthogranulomatous cholecystitis and gallbladder carcinoma WANG Guang-yi, SUN Xiao-dong, QIU Wei.Department of Hepatobiliary and Pancreatic Surgery, the First Bethune Hospital of Jilin University, Changchun 130021, China
Corresponding author: WANG Guang-yi, E-mail??wgymd@
sina.com
Abstract Xanthogranulomatous cholecystitis (XGC) is a rare type of cholecystitis, and the etiopathogenesis of XGC is not fully understood. It is difficult to differentiate XGC from gallbladder carcinoma by symptoms, physical examination, laboratory tests, and radiographic findings because of uneven thickening gallbladder wall and severe adhesions with surrounding organs, especially in some cases associated with gallbladder carcinoma. Preoperative and intraoperative diagnosis rate is poor. Preoperative and intraoperative fine needle aspiration cytology and frozen pathology is important to the intraoperative surgical management. Because of a high conversion rate (laparoscopic to open cholecystectomy) and incidence of complications with laparoscopic cholecystectomy, open surgery is suggested. The appropriate surgical procedures should be performed according to intraoperative frozen pathology results.     

Anticoagulant-induced hemorrhagic cholecystitis with hemobilia after deceased donor kidney transplant and literature review

Introduction and importanceHemobilia and hemorrhagic cholecystitis are uncommon causes of right upper quadrant abdominal pain. The development of intra-gallbladder and biliary bleeding has been primarily associated with abdominal trauma, malignancy, liver transplant, and iatrogenic injury to the biliary tree and vasculature. Spontaneous anticoagulant induced hemorrhagic cholecystitis and hemobilia are incredibly rare events and have only been documented by a handful of case reports.Case presentationA 55-year-old male who had recently undergone a deceased-donor kidney transplant was transferred to our academic institution for evaluation of subjective fever, right upper quadrant abdominal and back pain. The patient demonstrated localized tenderness in the right abdomen and was found to have hemorrhagic cholecystitis on imaging. He subsequently underwent urgent cholecystectomy and recovered without any subsequent complications.Clinical discussionHemorrhagic cholecystitis and hemobilia are a rare cause of right-sided or generalized abdominal pain. Diagnosis is made primarily by pathognomonic findings on CT and US imaging. Prompt diagnosis is essential in preventing mortality and/or significant morbidity. The standard treatment consists of urgent/emergent cholecystectomy.ConclusionA rare sequelae of anticoagulant use, intra-biliary bleeding must be considered as a differential diagnosis in anticoagulated patients presenting with right upper quadrant abdominal pain.     

三孔法腹腔镜胆囊切除术1000例治疗体会

目的　探讨三孔法腹腔镜胆囊切除术的可行性。方法　对我院 1 999年 1 0月～ 2 0 0 3年 1 0月 1 0 0 0例三孔法腹腔镜胆囊切除手术进行回顾性分析。结果　三孔法完成手术 96 3例 ,成功率 96 .3%。平均手术时间 4 8min ,平均术中出血 2 5ml,平均住院时间 2 .2d。有 4 3例改行四孔法腹腔镜胆囊切除术。中转手术 4例 ,1例为胆囊结肠瘘 ,3例为急性胆囊炎。胆总管误伤T管引流 1例 ,胆总管电凝伤 3例 ,经鼻胆管引流痊愈。结论　只要采用正确的手术操作方法 ,三孔法腹腔镜胆囊切除术是安全可行的     

Solitary metastatic gallbladder malignant melanoma originated from the nasal cavity: A case report

INTRODUCTIONSolitary gallbladder metastasis of malignant melanoma is rare and generally originates from skin melanoma. We report a case of gallbladder metastasis from a malignant melanoma of the nasal mucosa that was surgically treated.PRESENTATION OF CASEA 77-year-old Japanese woman diagnosed with malignant melanoma of the left sinonasal cavity three years ago underwent follow-up PET–CT and FDG uptake was detected only at the gallbladder. The nasal melanoma had been stable for the last 1.5 years after chemoradiation and her general condition was good. Cholecystectomy was performed with partial liver resection. Lymphadenectomy of the hepatoduodenal ligament was also performed. The tumor was soft and whitish, and was microscopically diagnosed as a poorly differentiated malignant melanoma that was not similar to the nasal cavity melanoma. No further metastasis is observed for more than 13 months after surgery.DISCUSSIONIn the literature, cutaneous melanoma is described as the origin of most metastatic gallbladder melanomas; however, no skin lesion was evident in this case. We believe that the poorly differentiated compartment of the nasal melanoma had metastasized to the gallbladder.CONCLUSIONFor patients with melanomas and gallbladder tumors, the possibility that metastasis could occur should be considered when selecting optimal treatment. Even when original melanoma is present, surgical treatment for gallbladder metastasis may be useful depending on the patient's conditions.     

Portsite and intraabdominal metastases of unsuspected gallbladder carcinoma after laparoscopic cholecystectomy: Report of a case

We herein report a rare case of portsite metastasis of gallbladder carcinoma which occurred after laparoscopic cholecystectomy. A 64-year-old man underwent laparoscopic cholecystectomy at another hospital for symptomatic cholecystolithiasis. The histological examination revealed an adenocarcinoma of the gallbladder infiltrating the entire wall. Despite the physician's advice the patient refused any additional treatment. Thirteen months after surgery he visited our hospital because of a palpable mass at the scar of the right trocar incision. The nodule was removed and histological examination confirmed metastasis from the gallbladder carcinoma.     

An unusual case of port site metastasis after laparoscopic cholecystectomy in a renal transplant patient: a case report

Port site metastasis after laparoscopy is a rarely seen intraabdominal malignancy independent of tumor stage. We present an unusual case of port site adenocarcinoma metastasis from unknown origin following laparoscopic cholecystectomy. A 52-year-old woman with a previous renal transplant underwent a laparoscopic cholecystectomy for symptomatic cholelithiasis. Six months later, she was admitted to the hospital with a complaint of a mass at the four trocar sites. A biopsy from the port sites led to the diagnosis of adenocarcinoma metastasis. Port site metastasis after laparoscopic cholecystectomy is seen especially after gallbladder cancer, and less frequently after intraabdominal malignancy independent of tumor stage. Our patient illustrated that port site metastasis probably spread from an undetected cancer site of an early stage intraabdominal tumor. Immunosuppression may have increased the likelihood of tumor seeding at the port sites.     

Acute acalculous cholecystitis caused by gallbladder metastasis due to the peritoneal dissemination of gastric cancer: A case report

Introduction and importanceAcute acalculous cholecystitis (AAC) is associated with a high mortality rate. AAC caused by metastasis to the gallbladder is rare. We report a case of AAC caused by gallbladder metastasis due to the peritoneal dissemination of gastric cancer.Case presentationAn 84-year-old male visited our hospital because of epigastric pain. Ultrasonography and computed tomography revealed swelling and thickening of the gallbladder wall, but stones were not observed in the gallbladder. We performed emergency surgery with a diagnosis of acute cholecystitis. Laparoscopy revealed the presence of many nodules around the abdominal cavity including the hepatoduodenal ligament. Inflammation of Calot’s triangle was severe, so we performed subtotal cholecystectomy. We also resected one of the peritoneal nodules. Macroscopically, there were no stones in the gallbladder and histopathological examination revealed acute cholecystitis and existence of adenocarcinoma involving the subserosa of the gallbladder wall and the resected peritoneal nodule. After surgery, esophagogastroduodenoscopy revealed Borrmann type II lesions at the antrum and gastric biopsy showed adenocarcinoma. He was diagnosed with advanced gastric cancer with peritoneal dissemination. His postoperative course was good.Clinical discussionThe cases of AAC caused by gallbladder metastasis have been little reported in the literature. This case is advanced gastric cancer with peritoneal dissemination and AAC was thought to be caused by peritoneal dissemination from operative and histopathological findings. We successfully treated this rare case of AAC with laparoscopic surgery.ConclusionAlthough metastasis to the gallbladder is rare, it is necessary to be aware of this possibility when treating AAC.     

Left-sided gallbladder (sinistroposition) with duplication of the common bile duct.

A left-sided gallbladder sinistroposition is a rare finding. These gallbladders are situated left of the falciform ligament and are located under the left lobe of the liver, between segments III and IV. Common bile duct duplication is also rare, and its cause is not yet fully understood. A 55-year-old woman presented to our hospital with symptoms of chronic cholecystitis. During the laparoscopic cholecystectomy, it was discovered that not only was her gallbladder to the left of the falciform ligament, but she also had a duplication of her common bile duct. Although cases of left-sided gallbladders have been reported in the past, and there has been a report of a sinistroposition of both gallbladder and common bile duct, we believe this is the first reported case of left-sided gallbladder sinistroposition with the complete duplication of the common bile duct. As we learn more about various anatomical anomalies of the gallbladder through the use of laparoscopic cholecystectomies, surgeons encountering a left-sided gallbladder should be aware of the potential for associated anomalies.